Almost one-third of the sites in the study used "elitist" language to describe the eating disorders, as if having the mental disorder was a special privilege. Researchers cited a polite example as "If you are looking to become anorexic or become bulimic by being here then please leave'' and a rude example as "IF YOU WANT TO LOSE WEIGHT, GO ON A DIET FATTY. ONE IS EITHER ANA/MIA, OR NOT. IT IS A GIFT AND YOU CANNOT DECIDE TO HAVE AN EATING DISORDER. SO IF YOU ARE LOOKING FOR A WAY TO LOSE WEIGHT, S-S-S-SORRY JUNIOR!! MOVE ON, TRY JENNY CRAIG."
At the same time, the researchers at Stanford and Johns Hopkins Universities found attempts to give support within the "ana" and "mia" sites.
Forty-two percent of the sites they studied provided venues for artistic expression, such as poetry, artwork, music and videos. Additionally, 38 percent of the sites included information on how to get help, along with recovery-oriented information.
Psychiatrists said that paradox of recovery and encouragement in pro-ana websites shows how even the most ill understand that the condition is dangerous.
"Even on these sites, there's an implication that it's not healthy," said Dr. B. Timothy Walsh at Columbia University Medical Center.
"One of the complicated features in treating individuals with eating disorders is ... ambivalence about recovery," said Walsh's colleague, Dr. Evelyn Attia.
"When someone suffers from depression, they're quite clear that they would prefer experiencing life without depression," she said.
But with eating disorders, Attia said, "for many folks, even those who pursue treatment, there's often a flirtation with not getting better."
"Often patients explain just how tricky the experience of encountering these sites is. There's a part of them that wants treatment yet there are these complicated messages out there," said Attia, a member of the American Psychiatric Association and director of the Center for Eating Disorders at Columbia University Medical Center and Weill Cornell Medical College in New York City.
Psychiatrists who treat anorexia said they are anecdotally all too familiar with these sites. Yet not much research has been done on the topic or how to combat the influence of pro-ana and pro-mia sites.
"Almost every single child I get over the age of 13 has been on at least one of them, or knows all about them, even if they haven't been on them," said Dr. Stephanie Setliff, medical director at the pediatric eating disorders program at Children's Medical Center in Dallas, Texas.
"The younger children under the age of 12 aren't on them as much, because parents are monitoring their Internet use," she said.
Setliff said her approach to treating young children hasn't been to ignore the sites. Instead, she said she views them as just one more negative influence that must be addressed.
"You can't pretend that they aren't there, so then you might as well engage the treatment as part of that [the sites]," she said.
She said it is similar to the fact that "teenagers now are a generation of children who have never not seen a Photoshopped photo in magazines," said Setliff, who is an associate professor at the University of Texas Southwestern Medical Center.
Dr. David Herzog, a child psychiatrist at Harvard Medical School and Massachusetts General Hospital, said he actually does not hear of many eating disorder patients who visit these sites.